Finally, Some Good News on Mortality Inequality

A new paper suggests that mortality rates are declining for younger Americans, both rich and poor.

By Dwyer Gunn

(Photo: Geraint Rowland/Flickr)

Over the course of the last year, several well-publicized papers have highlighted an alarming health trend in the United States: Poor, white Americans are dying younger than expected. A paper by the economists Anne Case and Angus Deaton published last Novemberin the Proceeding of the National Academy of Sciences found that the mortality rates of white, middle-aged Americans have increased since 1998. The researchers attributed the increase to higher suicide rates, drug overdoses, and alcohol-related complications.

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In another recent paper, a team of economists found that the gap between the life expectancies of the rich and poor actually increased between 2001 and 2014. And just last month, the Washington Post launched a year-long investigation into the “rising mortality rate among white women in midlife”—a project that was prompted by its own internal analysis’ conclusion that “white women have been dying prematurely at higher rates since the turn of this century.”

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But a new working paper (which expands on an article published in the journal Science last month) released by the National Bureau of Economic Research offers hopeful news. The researchers, Janet Currie and Hannes Schwandt, analyzed county-level mortality rates for Americans of all different ages. While they noted the same increase in the mortality rates of middle-aged white Americans (particularly women) between 1990 and 2010 that other researchers have uncovered, they also found that the mortality rates for younger Americans (infant, children, and young adults) decreased for both rich and poor Americans during that same time period. What’s more, young Americans in poor counties saw greater decreases in mortality rates than those in rich counties — for younger demographics, inequality in mortality rates actually decreased between 1990 and 2010.

“What’s going on for black men ought to be a much bigger story than what’s going on white women.”

Currie also emphasizes another one of their findings, which has shown up in past research but has been somewhat overshadowed by the trends in white mortality: African Americans, especially men, enjoyed stunning declines in mortality between 1990 and 2010. “Middle-aged white women had the lowest mortality rates of anybody, so it doesn’t take a lot to get a big increase in mortality rates,” says Currie, an economics professor at Princeton University and expert on childhood health. “What’s going on for black men ought to be a much bigger story than what’s going on white women. The changes going on for black men affect many, many more lives.”

There’s no single explanation for these trends. Declines in infant mortality, for example, are likely due to better access to medical care for pregnant women and infants. Children over a year old, for whom “unintentional injury” is the leading cause of death, meanwhile, may have benefited from improved nutrition policies and better access to health insurance — but also from safer cars, changing norms around drunk driving, greater caution for seat belts, and better car seat implementation. Currie suggests the diffusion of health-care technology has likely benefited poor Americans everywhere, and might explain some of the improvements black men have seen. Fast, effective, standardized treatments for heart attacks, for example, are now in place even at hospitals outside big cities; that wasn’t the case 30 years ago.

“This really isn’t a simple story,” Currie says. “This is more about lots of positive changes that are combining to have a really big impact. That’s really a more accurate story than to say that there’s one cause or another cause.”

Currie and Schwandt’s research suggests a brighter future. In some respects, the health of middle-aged Americans today reflects historical health decisions and investments, or the lack thereof, as opposed to current conditions. Middle-aged, poor white women, for example, were particularly slow to quit smoking as information about its health effects trickled out. In fact, women in this demographic smoked at higher rates in 2010 than in 1990, and research suggests that historical smoking patterns are a major driver of the mortality inequality in middle-aged women. Younger women, by contrast, smoke at much lower rates. As health behaviors and technologies continue to diffuse across demographic groups and geographies, the poor may begin to catch up — and perhaps already are catching up in younger demographics.

In other words, the recent mortality trends seen for poor, white Americans may not actually be a harbinger of dire things to come. “These findings suggest that at least part of the diverging mortality rates currently observed at older ages might be a temporary phenomenon driven by a strong improvement in health behavior which simply occurred with some lag among the poor,” Currie and Schwandt write in their paper.

Above all, this new research implies that, even in the face of economic challenges and growing income inequality, improvements in health-care access and technology can benefit Americans across the income spectrum — and there’s value in identifying what’s working rather than focusing exclusively on what’s not.

“The emphasis on the negative trends can send the message that there’s nothing we can do,” Currie says. “They [health outcomes] are very much dependent on policy. Different kind of health policies that are implemented can have a big effect.”